Urban Livelihoods and Food and Nutrition Security in Greater Accra, Ghana, Research Report 112, offers a compelling case study of the impact of urban life on the livelihoods, food security, and nutritional status of the poor in Accra. The authors use a mix of qualitative information and detailed household data from a 1996–97 survey taken in Accra and its peri-urban areas to examine food consumption and employment and income, as well as hygiene practices, sanitation conditions, and practices related to the care and feeding of children to determine their contributions to malnutrition. The Accra Urban Food and Nutrition Study is a collaborative effort of the International Food Policy Research Institute, the Noguchi Memorial Institute for Medical Research in Accra, and the World Health Organization. This report provides an overall framework for analyzing the linkages between livelihood security, nutritional security, and factors such as income, women’s labor, and child care practices.

In the past, only a small share of the African population lived in cities. Today in Sub-Saharan Africa the urban population is approaching 40 percent of the total. In 1997 the population of greater Accra was roughly 2.4 million and growing by about 4.7 percent a year. Those living below the poverty line climbed from about 9 percent in 1987 to 23 percent in 1993. Copious research on the rural poor cannot be applied to urban dwellers because many of the problems they face are different. The urban poor live in a cash economy and purchase processed foods rather than growing their own. Livelihood opportunities are limited. Environmental conditions in cities can be a major constraint, particularly the level of crowding and poor sanitation. Informal safety nets to help the vulnerable such as kinship and community networks are different in urban areas.

The study finds that men and women earn income very differently in Accra. Most men engage in skilled or unskilled labor, while women are more likely to be self-employed in petty trade or street food vending (Figure 1). In 1990 the ratio of informal-sector workers (such as street vendors) to those in the formal sector was five to one. By 1997 the ratio was seven to one.

To make ends meet, both men and women seek to diversify their income-earning activities, but most had limited success in doing so in the 30 days before the survey. Livelihoods in Accra have been under pressure for years as the traditional ways of earning a living among the indigenous Ga people— farming and fishing—have declined, owing to competition for land use and depletion of fish. Structural adjustment and the redeployment of government and parastatal workers have put thousands out of work. High inflation, lack of access to credit, and increases in the number of people seeking jobs in the city are all constraints to self-employment, which is the only remaining option for many people. These factors, combined with attempts to regulate self-employment, have led to conflicts with municipal government.

Most government safety nets ended with the economic crisis in Ghana in the late 1970s. Today the poor in Accra rely almost completely on informal and kinship safety nets. Many households, particularly those headed by women, rely heavily on gifts, re-mittances, and borrowing and lending: as much as 43 percent of total income is from interhousehold transfers (Figure 2). (This partly reflects the living arrangements of the Ga, under which, traditionally, men and women do not live together.)

In terms of current caloric intake, roughly 40 percent of households in Accra could be classified as food insecure. When current status is combined with a measure of vulnerability (proportion of total household budget devoted to food), 24 percent of households are classified as food-insecure, and an additional 40 percent are vulnerable.

Since 1993, the nutritional status of children in Accra has been deteriorating, with the prevalence of stunting (low height for age) at almost 18 percent and wasting (low weight for height) at 5.3 percent. Urban living presents particular problems in caring for children because women, usually the primary caregivers, must generate income. Fifty-five percent of the primary caregivers worked full time and took care of their children full time. The study does not show adverse effects on children when mothers work, although many mothers in the study felt that they were making a trade-off between the need to earn income and the need to provide adequate care for small children.

The study finds that higher incomes lead to greater food availability, higher-quality diets, and better health for the child but not to significantly improved care practices. The only factor that is found to bring about important improvements in care is mother’s education. Conversely, children who receive poor care are likely to be malnourished, regardless of household income (Figure 4).

The report finds that households cope with financial shortfalls in a variety of ways. When there is not enough money to purchase food for all household members, cheaper foods may be substituted for more preferred foods or the amount of money allotted per person for the purchase of street foods may be rationed. The purchase of street foods is in itself a coping strategy, even though the calories purchased are more expensive. Poor households may find it easier to come up with a few cedis per person to purchase food from street vendors than to buy all of the ingredients needed to prepare a dish at home. Mothers also cope by limiting their own food intake to ensure that children have enough to eat. Finally, people borrow money from friends or relatives to buy food.

Within neighborhoods, the food security and health status of households varied greatly. This finding is important because it means that variation in income, health, and nutrition outcomes in Accra is at the individual and household levels, not at the community level, so strategies targeted by neighborhoods are unlikely to be effective.

National policies that link urban and rural economic growth are important.

• For vulnerable groups such as female-headed households and working mothers and their children, every effort should be made to increase the level of women’s education.
• Messages on improved childcare and hygiene practices, such as proper breast feeding and weaning, should be directed to the health sector in general as well as to individual mothers.
• To slow the increase in imports, processed foods derived from domestically produced crops such as maize, yams, and plantains should be developed to meet the needs of the urban population. And both the quality and quantity of domestic rice should be improved.

On the city level, policies that address the special needs of the indigenous people, such as compen-sation for lost land, are imperative, as well as land-use policies to slow the destruction of land in the peri-urban areas of Accra. Occupational or household targeting and monitoring systems to provide safety nets for the food-insecure and vulnerable households wherever they may live in the city should be developed.

• Take steps to deal with the problems of the petty traders and street vendors.
• Reform the regulatory sphere of local governments to reduce harassment of the self-employed.
• Set aside certain areas of the central business district for pedestrians and petty traders only. (Building new markets away from the city center has so far not been successful.)
• Strengthen the capacity of traders’ associations to work directly with city authorities.
• Encourage street food vendors to form associations to self-inspect and regulate hygiene to prevent contamination, emphasizing participation and collaboration rather than control.

The problems identified in this report are likely to intensify over the next 20 years, not only in Accra but in many African cities. Governments and civil society organizations can do much to reduce the effects of rapid urbanization on the vulnerable, but the time to begin is now.